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Dependent Student Verification Worksheet_1_

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					                                                                                       2009-2010
RETURN TO:                                         Name of Financial Aid Applicant (Please print)

LANEY COLLEGE
                                                   Last                            First                     Middle
FINANCIAL AID OFFICE
                                                   Date of Birth:
900 FALLON ST.                                                                         Month                 Day               Year
OAKLAND, CA 94607
                                                   Student ID Number: __________________________________________________
(510) 464-3414

                     DEPENDENT STUDENT VERIFICATION WORKSHEET
 To receive financial aid, you must complete a process called “Verification.” Verification requires you to submit copies of your and your
 parent(s)’ financial documents (signed Federal income tax returns, W-2 forms, etc.) and provide other information and documents to your
 college Financial Aid Office. After a comparison of information on these forms and documents and the information on the FAFSA (Free
 Application for Federal Student Aid), you may need to make corrections using your SAR, or your college may send corrections
 electronically.
 What you should do:
    Fill out all sections of this form and return it to the campus Financial Aid Office.
    Submit all other required documents to the campus Financial Aid Office.
    Complete this process as soon as possible so that your financial aid won’t be delayed.
    If you have any questions about filling out this worksheet, talk to someone in the Financial Aid Office.

A. Family Information (for persons included in your parents’ household)
    List the people your parent(s) will support between July 1, 2009 and June 30, 2010. Include yourself, your parent(s) (including
    stepparent) even if you don’t live with your parents, and your parent(s)’ dependent children, even if they don’t live with your parent(s),
    IF (a) your parent(s) will provide more than half of their support from July 1, 2009 through June 30, 2010, OR (b) they would be
    required to give parental information when applying for Federal Student Aid). Include other people as part of your household only if
    they now live with your parent(s) and your parents provide more than half of their support AND will continue to provide more than half
    of their support from July 1, 2009 through June 30, 2010.
    Write the names of all household members. Also, write in the name of the college for any household member, excluding your parent(s),
    who will be attending college at least half-time between July 1, 2009 and June 30, 2010, and will be enrolled in a degree, diploma or
    certificate program. If you need more space, attach a separate page.

                                                                                                   Name of College (if half-time
                         Full Name                           Age       Relationship            attendance or more during 2009-2010)
     Student Applicant                                                Self




B. Student’s Tax Forms and Income Information
    B-1    Please submit a signed copy of your Federal tax return (includes the 2008 IRS Forms 1040, 1040A, 1040EZ, a tax return from
           Puerto Rico, or a foreign income tax return). If you did not keep a copy of the tax return, request a copy from your tax
           preparer or a copy of an Internal Revenue Service form that lists tax account information.
               Check here and attach signed Federal tax return.
               Check here if you will not file and are not required to file a 2008 Federal Income Tax Return.
    B-2    If you did not file and are not required to file a 2008 Federal Income Tax Return, list below your employer(s) and any income
           received in 2008, (use the W-2 form or other earnings statements, if available).

             Employer(s)                                                                                                2008 Amount
                                                                                                                    $
                                                                                                                    $
                                                                                                                    $


                                                    COMPLETE BOTH SIDES

210/DSVW (Rev. 11/27/10, rlq)
                                                                    2009-2010 Dependent Student Verification Worksheet (Continued)


     B-3      Funds received for child support, other untaxed income (e.g., disability, Military Living Allowance, Workman’s
              Compensation) and any other income not reported on a 2008 Federal tax return. (See Question 47 and Worksheet of the Free
              Application for Federal Student Aid (FAFSA) for help in identifying income (if any) to be reported.)

                                                    Source(s) of Untaxed Income                                                       2008 Amount
                                                                                                                                  $
                                                                                                                                  $
                                                                                                                                  $

C. Parents’ Tax Forms and Income Information
     C-1      Please submit a signed copy of your parents’ Federal income tax return (includes the 2008 IRS Forms 1040, 1040A, 1040EZ,
              a tax return from Puerto Rico, or a foreign income tax return). If you did not keep a copy of the tax return, request a copy
              from your tax preparer or a copy of an Internal Revenue Service form that lists tax account information.
                  Check here and attach signed Federal tax return.
                  Check here if your parent(s) will not file and are not required to file a 2008 Federal Income Tax Return.
     C-2      If your parent(s) did not file and are not required to file a 2008 Federal Income Tax Return, list below your parents’
              employer(s) and any income received in 2008, (use the W-2 form or other earnings statements, if available).

                Employer(s)                                                                                                           2008 Amount
                                                                                                                                  $
                                                                                                                                  $
                                                                                                                                  $
     C-3      Funds received for child support, other untaxed income (e.g., disability, Military Living Allowance, Workman’s
              Compensation) and any other income not reported on a 2008 Federal tax return. (See Question 95 and Worksheet of the Free
              Application for Federal Student Aid (FAFSA) for help in identifying income (if any) to be reported.)

                                                    Source(s) of Untaxed Income                                                       2008 Amount
                                                                                                                                  $
                                                                                                                                  $
                                                                                                                                  $

D. Signatures
     By signing this worksheet, we certify that all the information reported to qualify for federal student aid is complete and correct (at
     least one parent must sign).

                        WARNING: If you purposely give false or misleading information on this worksheet,
                                        you may be fined, sentenced to jail, or both.



     Signature of Applicant                                            Date


     Signature of Applicant’s Father/Stepfather                        Date         Signature of Applicant’s Mother/Stepmother                       Date

            DO NOT MAIL THIS WORKSHEET TO THE US DEPARTMENT OF EDUCATION.
  TAKE IT TO YOUR COLLEGE FINANCIAL AID OFFICE. DON’T FORGET TO SIGN YOUR TAX FORMS.

                                                           California Information Privacy Act
State and federal laws protect an individual’s right to privacy regarding information pertaining to oneself. The California Information Practices Act of 1977
requires the following information be provided to financial aid applicants who are asked to supply information about themselves. The principal purpose for
requesting information on this form is to determine your eligibility for financial aid. The Chancellor’s Office policy and the policy of the community
college to which you are applying for aid authorize maintenance of this information. Failure to provide such information will delay and may even prevent
your receipt of financial assistance. This form’s information may be transmitted to other state agencies and the federal government if required by law.
Individuals have the right of access to records established from information furnished on this form as it pertains to them.
The officials responsible for maintaining the information contained on this form are the financial aid administrators at the institutions to which you are
applying for financial aid. The SSN may be used to verify your identity under record keeping systems established prior to January 1, 1975. If your college
requires you to provide an SSN and you have questions, you should ask the financial aid officer at your college for further information. The Chancellor’s
Office and the California community colleges, in compliance with federal and state laws, do not discriminate on the basis of race, religion, color, national
origin, gender, age, disability, medical condition, sexual orientation, domestic partnership or any other legally protected basis. Inquiries regarding these
policies may be directed to the financial aid office of the college to which you are applying.


210/DSVW (Rev. 11/27/10, rlq)

				
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